Will Anyone be Normal?

Diagnosis and the DSM-5: Proposed Changes to Diagnostic Best Practice Offer a Staggering Range of 'New' Conditions. Sir Terry Pratchett and Others Weigh in on the Impact of Mental Health Diagnosis and the Ever-Shrinking Idea of Normalcy

LONDON, July 27, 2010 - This month Journal of Mental Health features a special issue on
diagnosing mental illness. The issue - which comes out just weeks after the
eagerly-awaited new draft of the Diagnostic and Statistical Manual of Mental
Disorders (DSM), the global diagnostic 'bible' for the field of mental health
medicine - includes a series of articles written by high profile mainstream
personalities on what a diagnosis of mental illness has meant to them.

Best-selling British author Sir Terry Pratchett, former prime ministers
of Australia and Norway, memoirist Mark Vonnegut (son of Kurt Vonnegut Jr.)
and some of the world's top mental health experts are among the line-up of
writers featured.

"Our journal is unique in emphasising the value of contributions from and
with consumers as well as from esteemed clinical experts," explains Professor
Til Wykes, Executive Editor of Journal of Mental Health. "The 'patient'
papers in this month's issue reflect on how a mental health diagnosis has
impacted the lives of these people."

"It is astonishing how long it takes some people to get diagnosed (I know
because they write to me)," says Sir Terry Pratchett, best-selling author of
the Discworld series. "I cannot help but wonder if this is because doctors
are sometimes reluctant to give the patient the stigma of dementia since
there is no cure."

"When in Paradise Lost Milton's Satan stood in the pit of hell and raged
at heaven, he was merely a trifle miffed compared to how I felt that day,"
explains Pratchett, about the day that he was diagnosed. "I felt totally
alone, with the world receding from me in every direction and you could have
used my anger to weld steel."

"It seems that when you have cancer you are a brave battler against the
disease, but when you have Alzheimer's you are an old fart," continues
Pratchett. "That's how people see you. It makes you feel quite alone."

The extreme impact of a mental health diagnosis - and the stigma attached
- puts enormous pressure on the whole field to ensure accurate and sensible
diagnoses.

"The publication of the fifth edition of Diagnostic and Statistical
Manual of Mental Disorders (DSM-5) is one of the most highly-anticipated
events in the mental health field," explains Daniel Falatko, Managing Editor
of Journal of Mental Health. "This is the first major rewrite of DSM in 16
years and history has warned us that even small changes to this manual can
have extraordinary repercussions in the diagnosis and treatment of mental
health issues."

DSM is published by the American Psychiatric Association (APA) and
contains descriptions, symptoms, and other criteria for diagnosing mental
disorders. These criteria provide a common language and clear definitions for
professionals who treat patients with mental disorders, helping to ensure
that their diagnoses are accurate and consistent, worldwide.

"However, critics of this issue of DSM are concerned with the
classification of novelty conditions as psychological disorders. In the new
edition, temper tantrums among toddlers and heartache over a lost spouse
could now be defined as mental health conditions," explains Jerome Wakefield
of New York University's Department of Psychiatry. "One of the most
frightening scenarios is the potential for medicating people - particularly
children - who haven't yet shown any signs of illness in a bid to 'treat'
them for Psychosis Risk Syndrome, as identified by the new draft of DSM-5."

Indeed, there is reason for concern. Changes to the previous version
(DSM-4) seem to have contributed to three false positive "epidemics"* - high
rates of attention deficit hyperactivity disorder, autistic disorder, and
childhood bipolar disorders. Other factors also contributed to fanning the
flames - in particular, drug companies marketing drugs for these diagnoses
not just to doctors, but also to the general public.** During the last
decade, how many doctors were harangued by worried parents into giving drugs
like Ritalin to children who didn't really need it?

One of the main controversies is that the further the guidelines are
expanded, the easier the likelihood that nobody will classify as "normal".
Technically, with the classification of so many new disorders, we will all
have disorders. This may lead to the belief that many more of us 'need' drugs
to treat our 'conditions'. Many of these drugs will have unpleasant or
dangerous side effects.

What is it like to live with the side effects of anti-psychosis drugs?
How does it feel to be labeled with a mental health illness? Does a situation
where more people feel they have a problem make it better or worse for those
who have been diagnosed with a mental health illness? Are we putting enough
time, effort and money into 'cures' for this area of healthcare? What is it
like to be diagnosed? These are some of the questions addressed by the
articles in this month's Journal of Mental Health.

The latest issue of The Journal of Mental Health is available on
www.informahealthcare.com/jmh

For access to the full issue of The Journal of Mental Health, including
free access to Sir Terry Pratchett's article, please logon to:
www.informahealthcare.com/jmh

*(Frances, 2010)

** (Moncrieff & Timimi, 2010; Moynihan, Heath, Henry, & Gotzsche, 2002)

For further information and/or an interview with the editor, please contact: kirstin.stocker at informa.com; +44-(0)7716-756-453